How long before Cytomel kicks in?

[jzzlvr13]

I have been taking Cytomel, 10 mcg split into two doses and 150mcg of Synthroid (down from 175 mcg) for almost a week. My TSH is 1.6. I have been experiencing depression and anxiety for a year and a half, as well as many other symptoms. The anxiety is the only problem remaining.
How long should it take to see impovement with Cytomel, if it will help? I don't  feel much difference, maybe a little less consistency in the anxiety...yesterday not too strong, today quite strong. Other than that, not difference in energy level, aches and pains etc. (I have severe arthritis which complicates everything in life!)
If the anxiety remains, could it be that I'm taking too much Cytomel and should reduce to 5mcg? I know it's a strong med but don't know if at the 5-10 mcg the difference is great, as I see some who take 50-75mcgs.
This anxiety is killing me...anticipation of it getting to be as bad as the physical response.
Thanks,
b

[Mark Lupo, M.D.]

I usually start with 5mcg 2x/day and some patients feel a benefit in 3-7 days while others it may take a few weeks.  I especially start with lower doses in patients with anxiety....

175mcg synthroid with tsh 1.6 -- would have suggested 150mcg synthroid with 5mcg cytomel 2x/day to start.

[ArmourGal]

I suffered terrible anxiety with hypo.  With taking 1/2 grain (60 mg) of Armour twice a day, I saw the anxiety lift enough at the two week point to stop taking anti-anxiety medication I'd taken for 10 years.  It was low dose though.  There is 9 mcg of T3 in one grain of Armour so I was taking about what you are taking now.  

It did take me months, however, to be rid of depression and anxiety and other psychiatric disorder from Hashi's/hypo.  The literature on this says that it can take anywhere from 2 - 12 months for the brain to heal and I can say I saw mental improvement even past the one year mark.  By that time, however, I was on 4 1/2 grains of Armour and thus getting considerably more straight T3 than you are taking - so that may have been the difference in my satisfactory recovery.    

I've read that the usual addition of Cytomel to an anti-depressant in refractory depression is 25 mcg...so again, one has to wonder if it's the higher doses of T3 that help heal the brain.  

I would also add that the first months after starting treatment were hard - with it feeling like my brain was actually throbbing at times.  And perhaps it was, the brain shrinks in hypo and maybe it was expanding back to normal.  I also had to do a lot of talking to myself and telling myself that the feelings (depression/anxiety/sucidal ideation) were not Real, but rather a manifestation of my brain hypothyroidism.  This was helpful to me in recovery I think, sorta like CBT perhaps...but I also think it is critical that the brain have adequate thyroid hormone to heal.  It is an interesting thing that a person can have "brain hypothyroidism" even when all the lab look good and I think perhaps this is one of the dilemmas in treating the psychiatric disorder of hypothyroidism.
Cindi

[Pirategold]

In early 2001, I was an emotional wreck, anxious, crying,  guilty, feeling worthless and hopeless,  My doctor gave me Prozac, I was taking medication for GERD (I think that is was it is called) and it turned out that I was overdosing on Levoxol.  TSH was .050!  I was phone counselling with a psychologist.  So, my experience is that one can overdose on,especially Levoxol and if you do not know how to read your tests results and have to rely on the doctor interpreting them, then you are at the mercy of the doctor trying to figure out what is going on.  Perhaps in my case I wasn't real clear about how much Levoxol I was taking, but I believe they need to impress on you how strong that medication can be. And to be accurate in reporting what you are taking.

Pirate

[jzzlvr13]

Thanks you for your comments. I am taking 150mcg of Synthroid, not 175 with the 10mcg of Cytomel. I was encouraged to see that the symptoms don't lift overnight. You always want that to happen. I guess I'll just be patient and see how it goes over the next few weeks and accept the anxiety in the morning as something I have to live with, take my xanax until my body tells me I don't need it any more. At least I think the Cytomel kept me from adding Zoloft to my increasingly complex medical cocktail. I was at the point that I thought I would have to get the depression under control medically and got a trial of Zoloft, but that has abated thank god, and now only the anxiety remains.
Last summer I was hyperthyroid with a .12 or so TSH and had every symptom known to man. At least it's mostly just anxiety and lack of energy at the moment. I should count my blessings! Thanks again for the input. It's always encouraging to know you're not alone in this struggle.
Barbara

[j.drake]

I just posted a comment on the question you posted today about anxiety and Cytomel?  Do you know what happened to that post?  I think I am losing my mind, did it disappear?

Jenni

[sohothief]

I just started armour thyroid (my doc is very conservative, although she did switch me from synthroid to armour at my request) and she has me on 15mg.  I have been on this for 6 weeks.  NO change.  Armourgal, not asking for advice; only some encouraging words.  I've been a "skinny" all my life, now I look pregnant.  And of course, ALL the symptoms of hypo.  Matter of fact, I lived with this for two years, was tested, and finally got positive test results.  I'm 58, have played in a rock band up until two yearsmago, and now feel like i'm a hairless old lady.  tired, hurting and pregnant.

[ancientmariner]

I don't think Armourgal can post here any more. I can answer your question - doctors used to dose thyroid by symptoms, and desiccated pig thyroid was what they used (now called Armour). A normal human thyroid puts out the equivalent of 3-5 grains of armour (180-300mg). According to the Forest Pharmaceuticals prescribing information, you should be increasing that dose by 1/4-1/2 grain (15-30mg) every 2 weeks until syptoms (symptoms) are relieved. Six weeks is way too long to be on such a low dose. Maybe you could go to the Forest website and print off the prescribing instructions to show your doctor.